Provider Demographics
NPI:1932358207
Name:DRAGON RISES SCHOOL OF ORIENTAL MEDICINE
Entity Type:Organization
Organization Name:DRAGON RISES SCHOOL OF ORIENTAL MEDICINE
Other - Org Name:DRAGON RISES COLLEGE OF ORIENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,AP,DIPL AC,
Authorized Official - Phone:352-371-2833
Mailing Address - Street 1:1000 NE 16TH AVE
Mailing Address - Street 2:BLDG. F
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4557
Mailing Address - Country:US
Mailing Address - Phone:352-371-2833
Mailing Address - Fax:352-371-2867
Practice Address - Street 1:1000 NE 16TH AVE
Practice Address - Street 2:BLDG. F
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4557
Practice Address - Country:US
Practice Address - Phone:352-371-2833
Practice Address - Fax:352-371-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2425261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center